Antisocial Personality Traits

Antisocial Personality Disorder

What is a personality disorder?

A personality disorder is, “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture,” according to the Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5-TR), published by the American Psychiatric Association. This behavioral pattern is often expressed across various domains of life and is a chronic, life long condition. The manner in which the individual thinks, feels, and behaves causes them significant problems in daily life.

• These problems are experienced across significant areas of the personal’s life.
• These problems started in childhood or adolescence and continue into adulthood.
• These issues are not caused by alcohol or substance abuse or another medical or psychiatric condition.

Antisocial Personality Disorder (ASPD)

Antisocial personality disorder is a deeply ingrained thought process that is characterized by irresponsible, delinquent or criminal behavior and exploiting others for personal gain. The symptoms of antisocial personality disorder fall on a spectrum of severity and receptivity to treatment.

What does Antisocial Personality Disorder (ASPD) look like?

Antisocial personality disorder is one of 10 personality disorders, defined in the DSM-V-TR. Antisocial personality disorder is a mental health condition that is characterized in the DSM-5-TR as “. . . a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.”

Antisocial personality disorder is a deeply rooted way of thinking and behaving that is centered on obtaining one’s objectives at any cost, despite the needs, rights, welfare, and safety of others. Manipulation, deceit, using charm, wit, and flattery to exploit others for personal gain or pleasure, is classic. Delinquent and criminal behavior without remorse is a trademark of antisocial personality disorder. Like other psychiatric conditions, there are varying levels of symptom severity in ASPD.

What does severe Antisocial Personality Disorder look like?

The following discussion pertains to severe antisocial personality disorder. These individuals repeatedly fail to conform to societal norms and laws. They persistently disregard the rights of others and appear to lack the sense of right and wrong, that equates to a conscience. A functioning conscience serves to inhibit people from committing impulsive, destructive, dangerous, illegal, or criminal acts. The mechanism of conscience in the individual with antisocial personality disorders appears undeveloped or absent. As a result, the individual may commit illegal, criminal, or lethal acts, without showing remorse. They may exhibit an exaggerated sense of self importance and arrogance, putting their needs and desires above those of anyone else. They may lack empathy and show contempt or indifference to the suffering they cause to others. They may experience intense irritability, agitation, aggressiveness, and physical violence.

Personal charm, wit, and deceit are used to exploit others for personal gain or pleasure. The individual typically lacks a sense of responsibility, with the potential for grave consequences for those around them, including their partners, and their children, exposing them to neglect, abuse, danger, and damaging experiences.

A parent or caretaker who has severe antisocial personality disorder can be incapable of functioning as a competent, loving parent. All children need a parent who protects them and prioritizes their needs and safety, above all else. These attributes are commonly not in evidence with the individual with antisocial personality disorder, and who may have little interest or patience for the rigors of parenting. A parent who has severe ASPD, may choose to allow a responsible adult, for example, the other parent or grandparent, to take over the day to day child rearing responsibilities.

Other problematic areas may be an unstable work history, impulsively quitting one job before having secured another, unexplained work absences, and evading or defaulting on financial obligations. Individuals may engage in impulsive reckless behavior, with disastrous consequences for themselves and others. This may include repeatedly engaging in irresponsible, risky sexual behavior, driving while intoxicated, or substance abuse.

Indeed, individuals with antisocial personality disorder have a high rate of alcoholism and substance abuse. A key feature of antisocial personality disorder is a lack of empathy and, frequently, a display of callous contempt for the feelings and suffering of others. Another hallmark trait is the denial of responsibility and personal accountability. Blaming the victim, making excuses and rationalizations, denying responsibility, or simply being indifferent to the painful impact of their decisions may be apparent. In addition, irresponsible, impulsive, and reckless behavior may lead to disastrous consequences to those around them. They may display an exaggerated sense of self esteem and may use charm, manipulation, and exploitation to achieve their financial or sexual objectives. These severe manifestations of ASPD do not pertain in every individual case.

How is Antisocial Personality Disorder diagnosed?

A diagnosis of antisocial personality disorder (ASPD) can only be made when the individual is 18 or older, and the symptoms meet the criteria for antisocial personality disorder, as discussed in the DSM-V. This includes a prevalent pattern of behaviors that show disregard for the rights and welfare of others, and a history of illegal activities that may result in violence and incarceration. This pattern began before age 15 and persists into late adolescence and adulthood.

Conduct disorder

Conduct disorder, diagnosed in childhood, is a key risk factor for antisocial personality disorder in adulthood. Although a childhood history of behavior consistent with conduct disorder is a prerequisite for a diagnosis of ASPD in adulthood, the majority of children with conduct disorder will not grow up to develop ASPD.

“Conduct disorder involves a repetitive and persistent pattern of behavior in which the social norms and rules and the basic rights other people violated,” according to the DSM-V.

There are four behavioral patterns that occur in youth and are characteristic of conduct disorder:

• Aggression to people or animals
• Lying, stealing, deceit
• Destruction of property
• Violating rules and age appropriate norms

It has been suggested that early psychiatric treatment for conduct disorder may mitigate the development or severity of antisocial personality disorder. Therefore, prompt psychiatric treatment upon diagnosis of conduct disorder in childhood may offer a window of treatment opportunity.

Diagnostic criteria for ASPD

For a diagnosis of ASPD, three or more of the following symptoms must be present:

• Failure to conform to social norms and a pattern of committing illegal acts
• A persistent pattern of deceitfulness, conning, and exploiting others for personal gain or pleasurable gratification
• Impulsive behavior; an inability to plan for the future
• An irritable mood, aggression, hostility, getting into fights, and engaging in violence
• Recklessly engaging in high risk behaviors without regard for the welfare of self or others
• A pattern of consistent irresponsibility, as evidenced by an unstable work history or defaulting on debt
• A lack of remorse and displaying a callous indifference to having harmed or stolen from others
• The individual must be at least 18 years old to diagnose antisocial personality disorder
• The individual’s history must be consistent with conduct disorder before age 15
• The antisocial behavior is not due to schizophrenia or bipolar disorder.

Individuals with ASPD may not acknowledge or believe that they need help. Nonetheless, they may share symptoms of depression, anxiety, relationships problems, anger management problems or alcohol or substance abuse with their primary care physician or mental health provider. This often leads to a referral for mental health evaluation.

People with antisocial personality disorder may not have an accurate perception of themselves and others. In order to obtain a more comprehensive picture of how the individual relates to others, it can be helpful to obtain their permission to speak with close family and friends.

Currently, there are no laboratory tests for the diagnosis of antisocial personality disorder. A diagnosis of ASPD is usually based on a complete physical exam and history, psychological evaluation, and a comprehensive personal history. This information is then compared with the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), published by the American Psychiatric Association. If the above data matches the DSM-V criterion, a diagnosis of ASPD is appropriate.

Who can diagnose Antisocial Personality Disorder?

Due to the complex presentation of antisocial personality disorder, evaluation and diagnosis by a trained mental health specialist is recommended. A primary care or other specialist may suspect antisocial personality disorder, and will normally refer the patient to a mental health specialist, who can determine whether a diagnosis of antisocial personality disorder applies. Psychologists, social workers, licensed professional counselors, psychiatrists, psychiatric nurse practitioners, and psychiatric physician assistants are trained to diagnose antisocial personality disorders.

How prevalent is antisocial personality disorder?

The lifetime prevalence rate of antisocial personality disorder among the general population is between 1% and 4%. Men are 3-5 times more likely to be diagnosed with ASPD than women. Results of a research study suggest that among men in substance abuse or forensic settings, a prevalence rate of ASPD was more than 70%.

Several childhood risk factors for developing ASPD have been identified. These include:

• A childhood history of severe behavioral problems, indicative of conduct disorder, or a diagnosis of conduct disorder
• A family history of antisocial personality disorder, or another personality or mental health disorder
• Being subjected to neglect or abuse in childhood, or a violent, unstable childhood home environment.

It should be noted that early identification and treatment of conduct disorder may offer a window of opportunity for mitigating the severity of antisocial behavioral patterns in later life.

The current thinking on what causes Antisocial Personality Disorder

The exact cause of antisocial personality disorder is not known, however, research suggests that factors, such as neurobiology, environment, genetics, addictions, and gender may increase vulnerability to antisocial personality disorder.

Brain development and unusual levels of serotonin, a neurotransmitter that regulates mood, has been identified as a possible risk factor. Childhood trauma and living with a family member who has antisocial personality disorder, or another personality, mental health, or addictive disorder are additional risk factors. Biological relatives of individuals diagnosed with ASPD are at increased risk of developing the disorder. A number of studies have suggested differing estimates of heritability of antisocial personality disorder from 38% to 69%.

Research has been done on establishing the precise gene that contributes to antisocial personality disorder and there is evidence implicating a specific region on chromosome 2.

Adoption studies indicate the interplay of both genetic and environmental factors in the development of antisocial personality disorder. An adopted child with a biological parent with antisocial personality disorder, may tend to display antisocial personality disorder characteristics, although neither of the adoptive parents has ASPD. In that case, the environment offered by the adoptive parents may mitigate the emergence of ASPD symptoms, although this theory remains unproven.

Addiction to alcohol and substances also plays a role. Approximately half of those with antisocial personality disorder also have addictions to alcohol or substances.

Finally, gender may play a role as men are more likely to develop ASPD than women.

Outlook

Research has been done into the clinical course of antisocial personality disorder and found that symptoms are at their worst between ages 24-40. After age 40, symptoms of ASPD start to improve for some people.

Another research study suggests that the ASPD symptoms of married individuals were less severe than their unmarried counterparts. Interestingly, for some individuals, having been briefly incarcerated appeared to act as a deterrent to future illegal behavior.